腹腔镜直肠癌术后早期吻合口并发症的防治

Prevention ＆ Treatment of Early Anastomosis Stoma Complication Following Laparoscopic Surgery for Rectal Carcinoma

为了探讨腹腔镜直肠癌前切术后早期吻合口并发症的发生原因及防治措施，回顾性分析215例腹腔镜直肠癌前切术后早期吻合口并发症发生情况及处理方法。结果显示，吻合口出血10例（4．65％，10／215）；发生时间≤24h6例，〉24h4例；2例保守治疗；1例术中腔镜下缝合止血，2例术中经肛缝合止血，3例术后经肛缝合止血，i例合并吻合口漏经腹缝合止血并行结肠造口术，均成功止血；1例经肛简单缝合止血失败后合并吻合口瀛，感染性休克死亡。吻合口漏5例（2．33％，5／215）；发生时间为术后3～7d；3例结肠造口术后痊愈；2例非手术治疗患者，1例保守成功，1例合并吻合口出血，感染性休克死亡。结果表明，腹腔镜直肠癌前切术后发现吻合口出血或吻合口漏应积极再手术治疗，慎重选择保守治疗方案。

This study was to explore the cause and prevention ＆ treatment measures of early anastomosis stoma complication following laparoscopic surgery in 215 cases, retrospectively analyzed the status On com- plication onset and relevant management methods.As results,in 10 cases anastomosis stoma bleeding oc- cured（10/215,4.65%） ;oceured time≤24 h,in 6 eases,〉24 h,in 4 eases;among the 10 cases,2 cases con- servative fherapy,1 received intraoperative laparoscopic suture to stop bleeding, 2 intraoperative t ransanal suture do so,3 postoperative transanal suture do so, 1 due to complicated with anastomosis stoma leakage received＇via abdomen suture do so, and colostomy, above cases were all stopped their bleeding ; but, 1 failed to stop bleeding with transanal simple suture, and complication with anastomosis stoma leakage, also infec- tious shock leaded to death;in 5 cases anastomosis stoma leakage occured（5/215,2.33 %）, at 3-7 d after op- eration;3 cases were cured after colostomy which in the 2 cases subjected to non-surgery,1 conserved sue- cessfuly, 1 complicated with anastomosis stoma bleeding,infectious shock to death.Results show taht after laparoscopic anterior resection for rectal carcinoma at once anastomosis stoma bleeding or leakage occur it should be actively performing secondary surgery,careful chosing Conservative therapy.